CSFP Monthly Reporting
Please be aware: This form is encrypted to keep your seniors' private and sensitive personal data protected from online threats. This means: You will not be able to save your progress and return later. When you sit down to complete the form, be sure all your documents are ready for submission. If all documents are downloaded and saved somewhere on your computer, it will allow for a quick and efficient submission. Remember that the only type of documents that can be submitted are PDFs, Excel sheets, and Word documents. If you have questions while completing this form, please call Dana Carhart at 757-201-6284 between the hours of 8 am-4:30 pm.
Agency Name & Number:
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Please Select
A0003- Oasis Social Ministries
A0013- Grace Lutheran Church
A0050- Plummer Plaza Senior Living
A0195- Kemet House
A0284- Bank Street Baptist Church
A0306- East End Baptist Church
A0487- Grace Place
A0618- 618 South St Food Hub
A0752- Jordan Newby
A0789- Silver Tree
AES032- Pungoteague
AMPC3- Cambridge Square
AMPCSFP0- Isabella Health Foundation
AMPF5- Springdale- Family 4 Eternity
Remaining Eastern Shore Sites
Full Name
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Phone Number
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Month
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Year (i.e. 2025 - enter 4 digits)
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Basic Info & Number Reporting for CSFP Boxes
What was the total number of CSFP boxes you received from the Foodbank this month?
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Be sure to count the boxes when they arrive AND THEN compare that number to the one on the delivery sheet. Please be diligent about saving those truck delivery sheets. This is when you should refer back to them if needed.
What was the total number of boxes distributed at your site this month?
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What is your total remaining inventory (leftover boxes/boxes not distributed)?
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How many CSFP boxes were damaged?
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How many CSFP cheeses were damaged?
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Please upload pictures of any damaged foods reported above.
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Forms Submission- Distribution Check Off Sheet
You may upload a picture/photocopy but ONLY after it's been converted to a PDF. To do so, please use any free phone app such as "HP Smart" or "Adobe Scan: PDF scanner" or "CamScanner-PDF Scanner App" to scan your photo to turn it into a PDF BEFORE submitting. We prefer a scanned PDF if you have ANY handwriting on your sign in sheet during your CSFP distribution. If you used a paper copy during distribution, and then utilized it to update your digital sign in sheet (in Excel), please only submit the final copy.
CSFP Monthly Distribution Check Off Sheet
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If you're not submitting a Word/Excel document, use a phone app to scan your photo and convert it into a PDF BEFORE submitting. Your distribution check off sheet upload MUST contain your waitlist. The waitlist must be visable in your upload/submission.
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CSFP Training Section:
Any volunteers who participate in the dissemination of CSFP boxes must be trained in the program and in Civil Rights annually. If you have trained any volunteers, they must fill out and sign the "Annual CSFP Volunteer Training Log." Please scan and upload this document here to show their signatures and date they were trained by you. The only documents that can be submitted are PDFs, Excel sheets, and Word documents. (If you have not yet attended training you will not have a copy of this log yet).
Did you train any volunteers/people who helped you at this month's CSFP distribution?
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Yes
No
Site Coordinator's Annual CSFP Volunteer Training Log
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Please upload a pdf photocopy of the Volunteer Training Log you received at training. This page should show any volunteers you have trained in CSFP
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Do you have any other volunteers you havent trained yet?
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Yes
No
If yes, how many volunteers do you have left to train in CSFP?
CSFP Application Section:
Applications submitted with ANY missing information is unacceptable and considered a violation with VDACS. It is site supervisors' responsibility to proofread, certify and qualify seniors. Please be diligent in your effort of ensuring seniors qualify for the program before submitting their application to the Foodbank. If an application is deemed ineligible, there should be a matching ineligibility letters submitted, given to the senior, and filed with your site's records. The only documents that can be submitted are PDFs, Excel sheets, and Word documents. Application file names must be: "lastname.firstname.certificationdate." REMEMBER: applications are NEVER submitted without an accompanying CSFP letter.
Did you receive any new filled out CSFP applications? (REMEMBER: a matching CSFP letter should also be submitted in section below).
Yes
No
Completed Application(s) and/or Recertifications(s)
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File name MUST be: "lastname.firstname.certificationdate." Example: Doe.Jane.7.25.2025. When submitting applications, please specify BELOW whether each application is for an active senior, a waitlisted senior, or a recertification.
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Use this space to list out each document uploaded above, as either a new application, a recertification or for a senior that has applied and been waitlisted. (Ex: Jon Doe-waitlisted, Jon Doe-active, Jon Doe- recertified).
If they're all waitlisted applications, please note that here. If they're all recertifications say: "all the applications uploaded are recertifications."
CSFP Storage Documentation Section:
If you store CSFP boxes for 12 or more hours, you must keep temperature logs for dry storage and refrigeration units. You must check the temperature of these rooms three times a week and document accordingly. The only documents that can be submitted are PDFs, Excel sheets, and Word documents.
Do you have a Foodbank approved storage space for CSFP boxes?
Yes
No
Temperature Log
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CSFP Letters
If you've accepted any applications this month, they MUST have a matching CSFP letter uploaded here. Please upload copies of any/all acceptance letters, discontinuation letters, ineligibility letters, or recertification letters sent or given out to seniors this month. Please ensure letters uploaded here. After doing so, they MUST BE placed in your CSFP site binder, STAPLED to the application of the senior it was given to, to allow for proper documentation. The only documents that can be submitted are PDFs, Excel sheets, and Word documents.
Did you send/hand deliver any CSFP letters this month?
Yes
No
Letters Sent This Month
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If you have accepted ANY CSFP applications from seniors this month, their MUST be an accompanying CSFP letter submitted here AND sent to senior.
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